Internal and emergency medicine
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Whether there is a link between venous and arterial thrombotic disorders is still a matter of debate. They share common risk factors, such as old age, male sex and obesity. Endothelial dysfunction and inflammation are likely to play a role in determining the simultaneous involvement of the two vascular compartments. ⋯ In particular, the direct oral anticoagulants have recently been shown to reduce the risk of both vascular disorders. In conclusion, recent evidence provides compelling evidence in support of the link between venous and arterial thrombosis. Future studies are needed to clarify the nature of this association, to assess its extent, and to evaluate its implications for clinical practice.
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Headache is a significant reason for access to Emergency Departments (ED) worldwide. Though primary forms represent the vast majority, the life-threatening potential of secondary forms, such as subarachnoid hemorrage or meningitis, makes it imperative for the ED physician to rule out secondary headaches as first step, based on clinical history, careful physical (especially neurological) examination and, if appropriate, hematochemical analyses, neuroimaging or lumbar puncture. Once secondary forms are excluded, distinction among primary forms should be performed, based on the international headache classification criteria. ⋯ Opioids should be avoided, for their scarce effectiveness in the acute phase, while IV hydration should be limited in cases of ascertained dehydration. Referral of the patient to a Headache Center should subsequently be an integral part of the ED approach to the headache patients, being ascertained that lack of this referral involves a high rate of relapse and new accesses to the ED. More controlled studies are needed to establish specific protocols of management for the headache patient in the ED.
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Review Meta Analysis
Serum albumin and risk of cardiovascular events in primary and secondary prevention: a systematic review of observational studies and Bayesian meta-regression analysis.
The predictive role of serum albumin (SA) has been evaluated in primary prevention studies. We want to assess the association of SA with the subsequent risk of cardiovascular events (CVE) in primary and secondary prevention studies. We performed a systematic review and Bayesian meta-regression analysis. ⋯ Females and males had a similar risk for CVE (HR 2.46, 95% CI 1.92-3.16, and HR 1.46, 95% CI 1.27-1.69, respectively). We found a similar risk of CVE between primary and secondary prevention studies (HR 1.79, 95% CI 1.5-2.17, and HR 2.47, 95% CI 2.24-2.75, respectively). Low SA levels are associated with an increased risk of CVE, not only in subjects free from CVE, but also in patients who already experienced a CVE.
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Review Meta Analysis
Serum albumin and risk of cardiovascular events in primary and secondary prevention: a systematic review of observational studies and Bayesian meta-regression analysis.
The predictive role of serum albumin (SA) has been evaluated in primary prevention studies. We want to assess the association of SA with the subsequent risk of cardiovascular events (CVE) in primary and secondary prevention studies. We performed a systematic review and Bayesian meta-regression analysis. ⋯ Females and males had a similar risk for CVE (HR 2.46, 95% CI 1.92-3.16, and HR 1.46, 95% CI 1.27-1.69, respectively). We found a similar risk of CVE between primary and secondary prevention studies (HR 1.79, 95% CI 1.5-2.17, and HR 2.47, 95% CI 2.24-2.75, respectively). Low SA levels are associated with an increased risk of CVE, not only in subjects free from CVE, but also in patients who already experienced a CVE.
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Addison disease is due to the destruction or dysfunction of the entire adrenal cortex. Nowadays, the causes of adrenal insufficiency are autoimmune disease for 70-90% and tuberculosis for 7-20%. Many typical signs and symptoms, such as hyponatremia, hyperkalaemia, or renal insufficiency can represent the reasons for a nephrology consultation, especially in conditions of urgency, and they can easily be confused with other causes. ⋯ The blood tests showed in all three patients severe electrolyte disorders and acute renal failure which will be discussed in their physiopathogenetic mechanisms. In a peculiar way, these alterations were not controlled with repolarizing solutions, fluid replacement and increased volemia, but only after steroid administration. In conclusion, in this review all the known pathogenic mechanisms causing disorders of nephrological interest in adrenal insufficiency are discussed.